Form Ems-43 - Emt-Basic Course Application And Schedule
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1
2New Jersey Department of Health
Office of Emergency Medical Services
EMT-BASIC COURSE APPLICATION AND SCHEDULE
This application will not be processed unless completed in its entirety.
Course Sponsor
Coordinator
Primary Instructor
Sponsor Contact
Address
ID Number
Sponsor Telephone No.
City, State, Zip
Day Telephone No.
Medical Director
ID Number
Night Telephone No.
Address
Day Telephone No.
Course Location
Telephone No.
Night Telephone No.
Class Days/Time
Text
Estimated No. Students
Course Fee
Time
Lesson
Course Session
Date
Day
Lecturer/Instructor and Title
(Start-End)
/ / / / /
MODULE 1 - Preparatory
/ / / / /
/ / / / /
/ / / / /
/ / / / / / / / / / / / / / / / / / / /
1-1
Introduction to Emergency Medical Care (1.5 hours)
1-2
Well-Being of the EMT-Basic (1.5 hours)
1-3
Medical/Legal and Ethical Issues (1.5 hours)
1-4
The Human Body (2.5 hours)
1-5
Baseline Vital Signs and SAMPLE History (2.0 hours)
1-5
Baseline Vital Signs and SAMPLE History
1-6
Lifting and Moving Patients (3.0 hours)
1-7
Evaluation: Preparatory Module (2.0 hours)
/ / / / /
MODULE 2 - Airway
/ / / / /
/ / / / /
/ / / / /
/ / / / / / / / / / / / / / / / / / / /
2-1
Airway (4.0 hours)
2-1
Airway
2-2
Practical Skills Lab: Airway (2.0 hours)
2-3
Evaluation: Airway Module (2.0 hours)
/ / / / /
MODULE 3 - Patient Assessment
/ / / / /
/ / / / /
/ / / / /
/ / / / / / / / / / / / / / / / / / / /
3-1
Scene Size-up (0.5) hours
3-2
Initial Assessment (1.0 hours)
Focused History and Physical Exam- Trauma Patients
3-3
(4.0 hours)
Focused History and Physical Exam- Medical Patients
3-4
(2.0 hours)
3-5
Detailed Physical Exam (1.0 hours)
3-6
On-Going Assessment (1.0 hours)
3-7
Communications (1.0 hours)
3-8
Documentation (1.5 hours)
3-9
Practical Skills Lab: Patient Assessment (8.0 hours)
3-9
Practical Skills Lab: Patient Assessment
3-10
Evaluation: Patient Assessment Module (2.0 hours)
EMS-43
JUL 12
Page 1 of 2 Pages.
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